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Jordan K. Turgeon/MEDILL

Patients with mild dementia are generally considered higher-risk drivers, according to an article recently published in Neurology. The American Academy of Neurology released updated guidelines this week to help doctors determine when patients with Alzheimer's disease or dementia are no longer safe drivers.

Updated guidelines remove the guesswork from taking away the car keys

by Jordan K. Turgeon
April 14, 2010


Source: American Academy of Neurology

To calculate a patient's Clinical Dementia Rating (CDR) under the updated guidelines, start by figuring out the patient's memory score. Then, figure out the patient's score for each of the secondary categories. If three or more of the secondary categories are above or below the memory score, use the majority of the secondary categories to determine the patient's CDR. If not, then use the memory score instead. (CLICK TO ENLARGE)


Source: American Academy of Neurology

A sample formula demonstrates how a patient's driving competence is analyzed using the new guidelines. After the Clinical Dementia Rating (CDR) is calculated - using the chart above  - additional risk factors are also identified and counted. Match up the CDR score with the number of additional risk factors and find where the patient falls on the relative risk spectrum. (CLICK TO ENLARGE)

Chicago doctor Diana Kerwin said she often must make the difficult decision whether or not a dementia patient can safely continue driving.

For Kerwin, an assistant professor in geriatrics at Northwestern University’s Feinberg School of Medicine, the matter is an issue of overall patient care.

“The basis of the discussion is always for patient and public safety,” Kerwin said. “I don’t want my patients to ever be harmed. Addressing safety, especially driving safety, is very important.”

A set of guidelines released Monday by the American Academy of Neurology will help doctors determine when patients with Alzheimer’s disease or other form of dementia are no longer safe behind the wheel.

“It’s an important issue,” said Dr. Donald Iverson, lead guideline author and member of the Humboldt Neurological Medical Group in Eureka, Calif. “We have an ethical obligation to protect patients and public safety and to do so based on the best information that we have available.”

This is an update from the set of guidelines released by the academy in 2000. A panel used the Clinical Dementia Rating (CDR) scale, along with other risk factors that weren’t included in the previous set of guidelines, to help identify patients at an increased risk of unsafe driving.

“I think [the guidelines] help the physician with what to focus on when they’re trying to assess if a person is safe to drive or not,” Kerwin said. “They gave some specific ways that a physician can actually assess at the bedside.”

The latest guidelines -- released in this week’s issue of Neurology -- cited recent studies that reported as many as 76 percent of patients diagnosed with mild dementia were still able to pass an on-road driving test, though these patients are generally considered higher-risk drivers.

The loss of driving privileges often means a significant loss of independence for those with Alzheimer’s disease and dementia. The grocery store, the pharmacy – even places of worship – and the communities they represent suddenly veer out of reach. This pain is lessened when other means of transportation are available, Kerwin said.

“We try to keep [patients] as independent as possible,” Kerwin said. “Most families are very willing to assist with transportation of family members if driving becomes an issue. We’re able to usually find alternative transportation modes for patients if we do come to that time.”

In Illinois, drivers 75 years of age and older are required to take a written driving examination each time they renew their license. By law, drivers must also have their physician sign a medical report form if the driver has any medical or mental condition that could impair their ability to safely drive a vehicle.

In practice, Kerwin said deciding when a patient is no longer safe to drive is a qualitative, case by case matter. But she’s optimistic about the updated guidelines’ application in a doctor-patient setting.

“There’s not a single test that we can do that definitively tells you how safe that person is behind the wheel,” Kerwin said. “The new guidelines can guide the physician in assessing driving during an office visit. The history of any tickets or accidents, agitated behavior, reduced driving, a family member with concern about driving safety, and dementia clinical stage using the CDR score can assist the physician in recommending discontinuation of driving for the safety of the patient, while still maintaining patient independence."

A complete set of the guidelines can be found in the April 12 online issue of Neurology.